Provider Demographics
NPI:1982293528
Name:KANITRA, MATTHEW FRENCH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:FRENCH
Last Name:KANITRA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 TROOPER CT
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-5450
Mailing Address - Country:US
Mailing Address - Phone:317-697-1680
Mailing Address - Fax:
Practice Address - Street 1:2340 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4108
Practice Address - Country:US
Practice Address - Phone:765-452-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026408A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist